Sonographic assessment of the optic nerve sheath in idiopathic hypertension

Department of Neurology, Justus-Liebig-University, Klinikstraße 33, 35385 Giessen, Germany.
Journal of Neurology (Impact Factor: 3.38). 04/2011; 258(11):2014-9. DOI: 10.1007/s00415-011-6059-0
Source: PubMed


The aim of this work was to investigate the potential of ultrasound-based optic nerve sheath diameter (ONSD) measurements in detecting raised intracranial pressure in patients with idiopathic intracranial hypertension (IIH) and to describe ONSD response to lumbar puncture. In ten patients with newly diagnosed IIH, transorbital sonography was carried out to assess ONSD, OND (optic nerve diameter), and optic disc elevation before and after lumbar puncture. Twenty-five patients with other neurological disorders served as controls. Subjects with IIH showed a significantly enlarged ONSD on both sides (6.4 ± 0.6 mm vs. 5.4 ± 0.5 mm in controls; p < 0.001). The best cut-off value of ONSD for detecting raised ICP was 5.8 mm with a sensitivity of 90% and a specificity of 84%. After lumbar puncture, ONSD decreased bilaterally (right 5.8 ± 0.7 mm, p < 0.004; left 5.9 ± 0.7 mm, p < 0.043). No post-puncture changes could be observed with regard to OND and optic disc elevation. Sonographic ONSD evaluation may be useful as an additional tool to identify patients with raised intracranial pressure, as in IIH. Furthermore, our data suggest a potential usefulness of this method for monitoring of treatment effects. The degree of ONSD response to lumbar puncture differs in subjects with IIH, which may possibly be related to findings of a defective CSF circulation in the optic nerve sheath in this disorder, a state that is referred to as optic nerve compartment syndrome.

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    • "Sonographic assessment of the optic nerve sheath diameter (ONSD) has proven to be a reliable test for non-invasive diagnosis of raised ICP in neurocritical patients [1] [2]. However, the available information on its value to appraise idiopathic intracranial hypertension (IIH) comes from a single observational study [3] and limited clinical isolated cases [4] [5] [6] [7] [8] [9]. The optic nerve is a tubular structure of about 5 cm in length in which its intraorbital segment is evaluable sonographically. "
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    ABSTRACT: Objective: Sonographic assessment of the optic nerve sheath diameter (ONSD) is a useful technique in detecting raised intracranial pressure (ICP) in neurocritical care patients. Its utility in idiopathic intracranial hypertension (IIH) is less known. The aim of this study was to evaluate the diagnostic accuracy of ONSD for detecting IIH.
    Full-text · Article · Dec 2015
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    • "Consequently, ICP is elevated in individuals who develop AMS symptoms. ONSD changes at altitude from an anatomical and technical perspective Several studies using optic nerve ultrasonography showed increased ONSD in patients with increased ICP due to severe brain injury (Geeraerts et al., 2007;Soldatos et al., 2008), intracranial bleeding (Moretti et al., 2009), or idiopathic intracranial hypertension (Bauerle and Nedelmann, 2011). Moreover, enlargement of the ONSD has been demonstrated in patients with increased ICP in hyperacute (within 6 hours of symptom onset) (Skoloudik et al., 2011), acute (within 48 hours of symptom onset) (Moretti et al., 2009), and subsequent stages (Lochner et al., 2014) of intracranial hemorrhage . "
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    ABSTRACT: Lochner, Piergiorgio, Marika Falla, Francesco Brigo, Michael Pohl, and Giacomo Strapazzon. Ultrasonography of the optic nerve sheath diameter for diagnosis and monitoring of acute mountain sickness: A systematic review. High Alt Med Biol. 16:195-203, 2015.- Despite extensive research on acute mountain sickness (AMS), the underlying pathophysiology remains unclear. Ultrasonography studies have shown that optic nerve sheath diameter (ONSD) correlates with intracranial pressure (ICP) in critical care patients, and recent studies report elevated ONSD values at high altitude. The aim of this review was to elucidate whether 1. measurement of ONSD could shed light on the pathophysiology of AMS, and 2. ultrasonography of the ONSD could support the diagnosis of AMS. Systematic search of MEDLINE (through Pubmed; from 1966 to 14 October 2014), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE databases. Six studies with 436 subjects (139 women, 297 men; 406 mostly Caucasian; 30 Nepalese) were included. A marked variability in ONSD was found across studies both at baseline and at high altitude. The variability in ONSD across the included studies and within each study limit the utility of ONSD measurement in the diagnosis of AMS. ONSD measurements might be useful from a population perspective, but the accuracy of optic nerve ultrasonography for single subjects and single point-in-time assessment for diagnosing AMS is questionable due to high individual variability in ONSD.
    Full-text · Article · Sep 2015 · High altitude medicine & biology
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    • "Several researchers found correlations between ICP and ONSD (Soldatos et al. 2008; Le et al. 2009; Moretti & Pizzi 2009; Moretti et al. 2009), some of them even showed 90% sensitivity and 84% specificity of the ONSD method in patients with intracranial hypertension (Bauerle & Nedelmann 2011). However, in this study, the sample size was very small (only 10 patients). "
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    ABSTRACT: Glaucoma is one of the leading causes of blindness worldwide. Historically, it has been considered an ocular disease primary caused by pathological intraocular pressure (IOP). Recently, researchers have emphasized intracranial pressure (ICP), as translaminar counter pressure against IOP may play a role in glaucoma development and progression. It remains controversial what is the best way to measure ICP in glaucoma. Currently, the ‘gold standard’ for ICP measurement is invasive measurement of the pressure in the cerebrospinal fluid via lumbar puncture or via implantation of the pressure sensor into the brains ventricle. However, the direct measurements of ICP are not without risk due to its invasiveness and potential risk of intracranial haemorrhage and infection. Therefore, invasive ICP measurements are prohibitive due to safety needs, especially in glaucoma patients. Several approaches have been proposed to estimate ICP non-invasively, including transcranial Doppler ultrasonography, tympanic membrane displacement, ophthalmodynamometry, measurement of optic nerve sheath diameter and two-depth transcranial Doppler technology. Special emphasis is put on the two-depth transcranial Doppler technology, which uses an ophthalmic artery as a natural ICP sensor. It is the only method which accurately and precisely measures absolute ICP values and may provide valuable information in glaucoma.
    Full-text · Article · Jul 2014 · Acta ophthalmologica
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